1. Field of the Invention
The present invention relates to surgical implants for repair of inguinal and femoral hernias and also for the repair of large ventral or incisional hernias.
2. Description of Related Art
At present time there are three types of laparoscopic inguinal repairs: 1) the transabdominal preperitoneal repair or TAPP, 2) intraperitoneal onlay mesh repair or IPOM, and 3) the totally extraperitoneal laparoscopic repair or TEP.
The TAPP and TEP procedures require extensive dissection of the preperitoneal space with the inherent risks of nerve or vascular injuries and a high incidence of hematoma or seroma formation. On the other hand the IPOM procedure is very appealing because of its speed and simplicity and also because it eliminates the risks related to the preperitoneal dissection. The only disadvantage is the possibility of complications related to adhesion formation but this can be overcome by using adhesion barrier materials such as expanded polytetraetylene (ePTFE).
In the majority of the cases the implantable prosthesis consists of a composite patch made of a physical barrier to prevent formation of adhesions on the peritoneal side, and a knitted polypropylene monofilament mesh on the outer side to promote ingrowth and incorporation of the mesh into the abdominal wall such as Composix from Bard, Inc. and Sepramesh from Genzyme, Inc. A different type of prosthesis is made of expanded polytetrafluoroethylene with a smooth surface on one side, and a corrugated surface on the other side (Goretex Dual Mesh). The smooth side faces the intestine and serves as an adhesion barrier, while the corrugated surface is applied against the abdominal wall to promotes fixation via cellular and collagen ingrowth.
U.S. Pat. No. 5,916,225, issued to Kugel, discloses a hernia patch having a first layer of inert synthetic mesh material selectively sized and shaped to extend across and beyond a hernia, and a second layer of inert synthetic mesh material overlies the first layer to create a generally planar configuration for the patch. The first and second layers are joined together by a seam which defines a periphery of a pouch between the layers. One of the layers has a border which extends beyond the seam and which has a free outer edge. An access slit is formed in one of the layers for insertion of a finger of a surgeon into the pouch to allow the surgeon to deform the planar configuration of the patch to facilitate insertion of the patch into the patient and to position the patch across the hernia.
U.S. Pat. No. 5,593,441, issued to Lichtenstein et al., discloses a composite prosthesis and method for limiting the incidence of postoperative adhesions. The composite includes a mesh fabric and a barrier which prevents exposure of the mesh fabric to areas of potential adhesion. The interstices of the mesh fabric are infiltrated by tissue which secures the prosthesis in place. The composite is positioned with the barrier relative to the region of potential adhesion, such as the abdominal viscera.
U.S. Pat. No. 5,147,374, issued to Fernandez, discloses a patch made from a rolled up first flat sheet of polypropylene or polytetrafluroethylene surgical mesh. One end of the rolled up mesh has multiple slits to provide multiple flared out flaps stitched to a second flat sheet of surgical mesh. The patch is compressed into a longitudinal cylindrical structure and is inserted through a trocar into an opening of a hernia. The rolled up first flat sheet is inserted through the opening and the flaps and second flat sheet are stapled to the patient's tissue adjacent the opening.
Other hernia repair devices are disclosed in U.S. Application Publication No. 2003/0181988 (Rousseau), 2003/0187516 (Amid et al.), U.S. Pat. Nos. 6,120,530 (Eldridge et al.), 4,769,038 (Bendavid et al.), 5,725,577 and 5,743,917 (Saxon).
During the last few years, laparoscopic inguinal repairs have been gaining ground among surgeons as compared to the open tension-free repairs particularly for the repair of recurrent or bilateral hernias. However the laparoscopic repairs involve the use of general anesthesia and expensive laparoscopic instruments and some times very expensive prosthetic materials. Furthermore the laparoscopic transabdominal techniques are associated with some risk of visceral or vascular injuries related to the insertion of ports but this risk is minimized due to the experience gained by surgeons during the last two decades.
The implantable prosthesis devices disclosed in the art are burdened by a number of disadvantages and are often not well suited for use in laparoscopic hernial repairs. Accordingly, there exists a need for an improved implantable prosthesis for laparoscopic repair of inguinal or femoral hernias, and also for the laparoscopic repair of large incisional ventral hernias. There further exists a need for such a prosthesis that assists the surgeon in guiding the prosthesis into position upon insertion. A need also exists for a laparoscopically implantable prosthesis wherein fixation of the prosthesis can be accomplished precisely along the peripheral edge of the prosthesis using a spiral tacker.